IN-SITU HYBRIDIZATION STUDIES OF CYTOMEGALOVIRUS AND EPSTEIN-BARR-VIRUS IN REACTIVE HISTIOCYTIC HYPERPLASIA WITH HEMOPHAGOCYTOSIS

We studied 14 adult patients presenting with fever and cytopenia of th e peripheral blood and histiocytic hyperplasia with hemophagocytosis ( HHH) in the bone marrow regarding an association of cytomegalovirus (C MV) and Epstein-Barr virus (EBV) by using in situ hybridization (ISH) and also evaluated the clinical and laboratory findings according to t he encountered organisms. ISH using a CMV RNA probe demonstrated infec ted cells in 6 out of 14 cases (43 %), and ISH using an EBV EBER RNA p robe demonstrated infected nuclei in 5 out of the same 14 cases (36%) of HHH. No cases showed a positive reaction with both probes. Three ca ses showed a negative reaction with both probes. The mean age of all p atients was 29 years; and that of the CMV-positive patients was 27 yea rs and that of the EBV-positive patients was 36 years. Organomegaly wa s found in 3 out of 6 CMV-positive patients (1 hepatomegaly, 1 splenom egaly, 1 hepatosplenomegaly), and 4 out of 5 EBV-positive patients (ly mphadenopathy in all 4 cases, hepatosplenomegaly in 2 cases). One of t he CMV-positive case had acute myeloblastic leukemia, and 2 EBV-positi ve cases had underlying malignancy (1 Hodgkin's disease, 1 non-Hodgkin 's lymphoma). Seven out of the 14 HHH cases (50%) died within several months after diagnosis. Nucleic acid hybridization methods can be used for the routine examination of the association of CMV or EBV.